In this interview, Torsten Madsen, CEO of Hoba Therapeutics, shares insights about the challenges and opportunities in developing new medications for managing pain, especially for chronic neuropathic pain—a type of long-term pain caused by nerve damage. Neuropathic pain affects over 400 million people worldwide, and in Europe, about 6 to 8% of the general population lives with this condition. Currently, chronic neuropathic pain is mostly treated with three types of medications: antidepressants (such as tricyclic antidepressants and SSRIs), antiepileptic drugs (like pregabalin and gabapentin), and opioids. However, these treatments have significant limitations. They often do not directly address the root cause of the pain, such as nerve damage, and their effectiveness decreases if the underlying problem cannot be fixed. This means patients may need to try multiple medications, leading to side effects that can be just as troublesome as the pain itself. Camilla Petrycer Hansen from Novo Holdings, a major investor in healthcare, has pointed out that chronic pain has been overlooked for years because there hasn’t been enough innovation in treatments for it. Developing new pain medications is extremely difficult. Clinical trials for these drugs face unique challenges, making it hard to test their effectiveness properly. One major issue is that current treatments don’t always target the specific causes of pain. For example, nerve damage may not heal, so medications that rely on reversing this damage won’t work well. Additionally, research models used to study pain in the lab or in early trials aren’t always reliable or accurate in predicting how a drug will work in real patients. To improve this, scientists are now focusing more on better testing methods, like Quantitative Sensory Testing, which helps measure how patients’ nerves respond to pain. They are also conducting earlier studies to understand how drugs work in the human body before moving to larger trials. The current treatments for chronic pain, including opioids, often force patients into a difficult choice: they can either get some pain relief but suffer from severe side effects, or they can reduce side effects but continue to live with pain. This cycle of trying different treatments leads to less-than-ideal results for many patients. Looking ahead, there are three key trends in pain medication development. First, pharmaceutical companies are shifting away from creating drugs that target opioid receptors, which means fewer new opioid-based medications are being developed. Second, early-phase studies are becoming more informative, helping researchers better understand which patients might benefit from a drug and what outcomes to measure. Third, new types of treatments, based on different mechanisms, are being developed and are attracting interest from major pharmaceutical companies. One promising shift is the growing attention from Big Pharma—large pharmaceutical companies—toward neuroscience and pain treatment research. Over the past decades, there has been little progress in creating innovative treatments for chronic pain, leaving patients and caregivers with few options other than balancing between pain relief and side effects. The rising interest from Big Pharma suggests that this might change, offering hope for better treatments in the future. Torsten Madsen, the CEO of Hoba Therapeutics, has extensive experience in drug development across many areas and has led research programs in both publicly and privately held companies. His background includes clinical training in psychiatry and a focus on developing treatments for brain-related conditions. He holds an MD and a PhD from Copenhagen University, along with postdoctoral research experience at Yale Medical School.